Important notes• Has a Max Capacity of 500ml• Pyramidal in shape• It’s muscle coat is called the Detrusor Muscle    • Pres...
Nerve Supply is formed from the Hypogastric PlexusesSympathetic (Sensation of Fullness of the bladder and Pain) : Originat...
Sympathetic (Sensation of Fullness of the bladder and Pain) : Originates from the 1 st and 2nd Lumbar Ganglia to form theH...
Sympathetic (Sensation of Fullness of the bladder and Pain) : Originates from the 1 st and 2nd Lumbar Ganglia to form theH...
   Plexus : A network of intersecting nerves, blood    vessels or lymph vessels   Ganglia / Ganglion: Collection of nerv...
   Before                              Today’s Theory    › Sympathetic Nerves inhibit         › Sympathetic Nerves have ...
Clinical Notes• Urinary Calculus : Stone formed in any part of theurinary system also known as Kidney stone and/or RenalCa...
Picture Rendering   Actual Dissection
 The reflex is initiated when the volume of the  urine reaches 300 ml Stretch receptors in the bladder wall are  stimula...
 Efferent impulses also pass to the urethral  sphincter via the pudendal nerve (S2, S3, and  S4), and this undergoes rela...
   Children                    Adults    › A simple reflex that       › The same simple      acts and takes             ...
Clinical Notes•Overflow  Incontinence : When sensory fiber nerves fromthe bladder to the spinal cord are destroyed prevent...
   The micturition reflex is the basic cause of    micturition, but the higher centers of the brain    (cortex) normally ...
   Usually initiated in the following way:    1. A person voluntarily contracts his or her       abdominal muscles, which...
Important Notes• The function of the kidney is to excrete most of thewaste products of metabolism. They play a major role ...
 Urine formation begins when a large amount  of fluid that is virtually free of protein is filtered  from the glomerular ...
A comprehensive report on   the innervation of the
A comprehensive report on   the innervation of the
A comprehensive report on   the innervation of the
A comprehensive report on   the innervation of the
A comprehensive report on   the innervation of the
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A comprehensive report on the innervation of the

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A comprehensive report on the innervation of the

  1. 1. Important notes• Has a Max Capacity of 500ml• Pyramidal in shape• It’s muscle coat is called the Detrusor Muscle • Pressure in the bladder when Detrusor Contracts is 40 – 60 mm Hg • It’s thickened circular component of the muscle coat found on its’ neck is called the Sphincter Vesicae (Involuntary) • Synonyms: annulus urethralis, internal urethral sphincter, musculus sphincter vesicae, preprostate urethral sphincter,proximal, sphincter muscle of urinary bladder. • External Sphincter of the Bladder (Voluntary)
  2. 2. Nerve Supply is formed from the Hypogastric PlexusesSympathetic (Sensation of Fullness of the bladder and Pain) : Originatesfrom the 1st and 2nd Lumbar Ganglia to form the Hypogastric PlexusesParasympathetic (Motor; Internal Sphincter; Detrusor Muscle; Involuntary): Originates from the 2nd, 3rd, and 4th Sacral Nerves to form the PelvicSplanchnic Nerves • Most afferent sensory fibers from the bladder reach the CNS via the Pelvic Splanchnic Nerves • Some afferent fibers travel with the sympathetic nerves via the Hypogastric PlexusesThe Detrusor Muscle fuse with one another so that low-resistanceelectrical pathways exist from one muscle cell to the other making anaction potential spread throughout it, causing the entire bladder tocontract at onceSomatic Nerve Fibers (Motor; External Sphincter; Voluntary): Skeletalmotor fibers that innervate and control the voluntary skeletal muscle ofthe sphincter are transmitted through the Pudendal Nerve
  3. 3. Sympathetic (Sensation of Fullness of the bladder and Pain) : Originates from the 1 st and 2nd Lumbar Ganglia to form theHypogastric PlexusesParasympathetic (Motor; Internal Sphincter; Detrusor Muscle; Involuntary) : Originates from the 2 nd, 3rd, and 4th Sacral Nerves toform the Pelvic Splanchnic Nerves
  4. 4. Sympathetic (Sensation of Fullness of the bladder and Pain) : Originates from the 1 st and 2nd Lumbar Ganglia to form theHypogastric PlexusesParasympathetic (Motor; Internal Sphincter; Detrusor Muscle; Involuntary) : Originates from the 2 nd, 3rd, and 4th Sacral Nerves toform the Pelvic Splanchnic Nerves
  5. 5.  Plexus : A network of intersecting nerves, blood vessels or lymph vessels Ganglia / Ganglion: Collection of nerve cells forming a knot like shape and usually lying outside the brain and spinal cord (Outside CNS) Afferent : Carrying inward or towards the Center (Brain), as a nerve carrying a sensory impulse to the brain Efferent : Carrying outward or away from the center (Brain), as a nerve carrying impulses from the brain to a muscle, gland or other effector organ Action Potential : Electrical charge developed in a muscle or nerve cell that leads to its discharge or contraction Distended / Distention: State of being stretched out or enlarged
  6. 6.  Before  Today’s Theory › Sympathetic Nerves inhibit › Sympathetic Nerves have little or contraction of the detrusor no action on the smooth muscle muscle of the bladder wall of the bladder wall and are and stimulate closure of the distributed mainly to the blood sphincter vesicae vessels and plays a minor role in the contraction of the sphincter › Parasympathetic Nerves vesicae stimulate contraction of the detrusor muscle of the › In males the Sympathetic bladder wall and inhibit the Innervation of the sphincter action of the sphincter causes active contraction of the vesicae bladder neck during ejaculation, thus preventing the semen to enter the bladder
  7. 7. Clinical Notes• Urinary Calculus : Stone formed in any part of theurinary system also known as Kidney stone and/or RenalCalculus• Urinary Hesitancy : Difficulty in beginning the flow ofurine and decrease in the force of the urine stream. Inmen it is associated with prostate gland enlargement; inwomen with narrowing of the opening of the urethra orobstruction between the bladder and urethral it mayalso be caused in either sex by emotional stress andother factors
  8. 8. Picture Rendering Actual Dissection
  9. 9.  The reflex is initiated when the volume of the urine reaches 300 ml Stretch receptors in the bladder wall are stimulated an transmit impulses to the CNS, this gives the individual the conscious desire to micturate (urinate) Sensory signals from the bladder are conducted to the sacral segments of the cord through the pelvic nerves and then reflexively back again to the bladder through the parasympathetic nerve fibers by way of these same nerves. These impulses from the parasympathetic nerve fibers causes the Detrusor Muscle to Contract and at the same time make the Urethral Sphincter Relax
  10. 10.  Efferent impulses also pass to the urethral sphincter via the pudendal nerve (S2, S3, and S4), and this undergoes relaxation. Once urine enters the urethra, addition afferent impulses pass to the spinal cord from the urethra and reinforce the reflex action › Note: Micturition can be assisted by contraction of the abdominal muscles to raise the intra- abdominal and pelvic pressure and exert external pressure on the bladder › Muscles that compress abdominal Contents :  External Oblique, Internal Oblique, Transversus, Rectus Abdominis
  11. 11.  Children  Adults › A simple reflex that › The same simple acts and takes reflex is inhibited by place whenever the the Cerebral Cortex bladder becomes until the time and distended. place for micturition are favorable › Voluntary Movement is Controlled by Brodmann’s Area 4,6,8
  12. 12. Clinical Notes•Overflow Incontinence : When sensory fiber nerves fromthe bladder to the spinal cord are destroyed preventingtransmission of stretch signals from the bladder a personloses bladder control. Instead of emptying periodically, thebladder fills to capacity and overflows a few drops at a timethrough the urethra.•Automatic Bladder caused by spinal cord damage abovethe Sacral Region : Since the damage is above the sacralregion normal micturition reflex can occur. However theyare no longer controlled by the brain. Hence periodic butunannounced bladder emptying occurs.
  13. 13.  The micturition reflex is the basic cause of micturition, but the higher centers of the brain (cortex) normally exert final control of micturition as follows: 1. the micturition reflex partially inhibited, except when micturition is desired 2. Prevent micturition, even if the micturition reflex occurs, by continual tonic contraction of the external bladder sphincter until a convenient time presents itself 3. When it is time to urinate, the cortical centers can facilitate the sacral micturition centers to help initiate a micturition reflex and at the same time inhibit the external urinary sphincter so that urination can occur.
  14. 14.  Usually initiated in the following way: 1. A person voluntarily contracts his or her abdominal muscles, which increases the pressure in the bladder and allows extra urine to enter the bladder neck and posterior urethra under pressure, thus stretching their walls 2. This stimulates the stretch receptors, which excites the micturition reflex 3. Simultaneously inhibits the external urethral sphincter allowing urine to flow
  15. 15. Important Notes• The function of the kidney is to excrete most of thewaste products of metabolism. They play a major role incontrolling the water and electrolyte balance within thebody• The urine is propelled along the ureter by peristalticcontractions of the muscle coat, assisted by the filtrationpressure of the glomeruli
  16. 16.  Urine formation begins when a large amount of fluid that is virtually free of protein is filtered from the glomerular capillaries into Bowman’s Capsule. As the filtered fluid leaves Bowman’s capsule and passes through the tubules, it is modified by reabsorption of water and specific solutes back into the blood. The rate at which the substance is excreted in the urine depends on the relative rate of filtration, reabsorption, and secretion. Urinary excretion rate = Filtration rate – Reabsorption rate + Secretion rate

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